High blood pressure, heart conditions, older age – these are all risk factors for more severe Covid-19 disease, and now David Kass, a cardiologist at Johns Hopkins, and colleagues around the country have found that obesity is also a risk, and that’s a problem as the pandemic moves across certain areas of the US.

Kass: In the US it varies but overall the obesity rates are more like 40%. It was also looming that this could be a real issue as the disease went from western California and the Northwest where BMIs in the US are more like Europe and New York, where the average BMI is actually kind of like Europe so 20%ish. Now it’s moving into the South and the Midwest of the nation where obesity rates are higher. You end up seeing more in the 40% range. :31

Kass says people need to factor this in in their own assessments of risk. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: If you’ve been hospitalized for COVID-19 and are recovering, you may find yourself in a field hospital, Elizabeth Tracey reports

Some patients who’ve been hospitalized with COVID-19 will require ongoing care, and to that end, many organizations are working together to create solutions. Lisa Maragakis, director of infection control at Johns Hopkins, describes the initiatives.

Maragakis: States and public/private partnerships have come together to put together healthcare delivery for patients after discharge. How much capacity is going to be required for rehabilitation services, patients who may have a prolonged time on mechanical ventilation and need to go to a place where they can come off of the ventilator, also opening alternate care center sites such as in convention centers so that we have a way to decompress the hospital. :32

Maragakis applauds these cooperative endeavors to achieve the best care possible for those recovering from COVID-19. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: US populations with COVID-19 are often younger than those seen elsewhere, Elizabeth Tracey reports

One risk factor for more severe COVID-19 disease that emerged from China and Europe was older age, but as the pandemic has spread across the US, more younger people seem to be requiring hospitalization. That’s according to Lisa Maragakis, director of infection control at Johns Hopkins.

Maragakis: We have seen a much younger population of patients admitted to the hospital and even requiring intensive care and sometimes unfortunately dying from the infection. Initially reports centered around older individuals and those with a lot of comorbidities, underlying heart disease, pulmonary disease, diabetes, and now we see a much wider, in the United States, age distribution, really from the majority of patients from the ages of thirty to sixty. :33

Anchor lead: Why do some people with COVID-19 decline so suddenly? Elizabeth Tracey reports

COVID-19 infection is challenging from a number of clinical perspectives, not least of which is that in some people who seem to be getting better, things may suddenly and dramatically get far worse. Lisa Maragakis, director of infection control at Johns Hopkins, comments.

Maragakis: We’re not sure exactly why this happens. In some cases it may be other organs become involved in the infection and cause the worsening clinical picture. Sometimes this is known to be infection of the heart muscle or multiorgan failure in the setting of the low oxygen levels. Certainly vigilance even for those who are recovering at home or who have been admitted to the hospital and then been discharged we have to be vigilant that even after they seem to have recovered that they may have that clinical worsening. :31

Maragakis advises that anyone who has been diagnosed with COVID-19 needs to be aware of this possibility and should seek immediate care. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What does a virus have to do to succeed? Elizabeth Tracey reports

SARS-CoV2 has an agenda, one that helps it spread from one host to another in a quest to make billions of new copies of itself. Lisa Maragakis, director of infection control at Johns Hopkins, describes what constitutes success from the virus’s perspective.

Maragakis: When you look at a pathogen from a pathogen’s standpoint success is sometimes driven by having a lower mortality rate and being more efficient at transmission from person to person but not killing your host. And that’s what we’ve seen with this virus. We are now in the midst of transmission widespread and in all states in the United States and really around the world. We all know I’m sure the significant challenges we are facing. :28

Maragakis notes that SARS-CoV2 has a number of advantages in its quest, especially the fact that so many people don’t have symptoms at the beginning of the infection but are making many, many copies of the virus and often spreading it readily. At Johns Hopkins, I’m Elizabeth Tracey.

SARS-CoV2, the virus that causes COVID-19, is just one of the family of coronaviruses that have been around for centuries. Lisa Maragakis, director of infection control at Johns Hopkins, reviews the history.

Maragakis: They have been with us as human pathogens for a very long time and are actually responsible for at least ten if not up to thirty percent of all upper respiratory infections including what we term the common cold, and generally considered to be inconsequential. This particular version of a coronavirus is not at all inconsequential. It follows other family members including SARS and MERS as coronaviruses that cause extremely severe respiratory illness and death in many people. :33

Maragakis says such an historical perspective may provide important clues with an eye toward slowing the pandemic, developing treatments and vaccines. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What can be done to help minority populations avoid COVID-19 infection? Elizabeth Tracey reports

Minority groups are experiencing increased risk for COVID-19 disease and death, US data show, with the CDC set to release numbers some time in May. For now, Sherita Golden, Johns Hopkins vice president and chief diversity officer, says developing specific messaging to help these communities understand their risk is key.

Golden: We really have to take the social distancing seriously. We need to reduce the stigma associated with having the illness. So that people don’t feel embarrassed and feel empowered to go get medical treatment if they’re not doing well because that’s also going to prevent them from exposing other people. Not hiding symptoms and honestly telling other friends and family that they are symptomatic so they can seek treatment and quarantine appropriately. Some of the responsibility lies with us as an overall community and a public health system to really address those social conditions that continue to put these populations at risk. :34